1 - Maryland



Budget Narrative Form – [Insert Program Name]SALARIES/WAGES Position Title and NameAnnual SalaryTimeMonthsDHMHAmount RequestedTotal AmountTOTAL DHMH SALARIES/WAGES AMOUNT REQUESTED$_ 4762534099500Summary Justification:FRINGE BENEFITSFringe BenefitPercentage of SalaryDHMH Amount RequestedTotal AmountRetirementFICAInsuranceWorkers CompensationFringe BenefitPercentage of SalaryDHMH Amount RequestedTotal AmountRetirementFICAInsuranceWorkers CompensationFringe BenefitPercentage of SalaryDHMH Amount RequestedTotal AmountRetirementFICAInsuranceWorkers CompensationTOTAL DHMH FRINGE BENEFITS AMOUNT REQUESTED$ CONSULTANT COSTSName of Consultant: Organizational Affiliation (if applicable): Nature of Services to Be Rendered: Relevance of Service to the Project: Number of Days of Consultation (basis for fee): Expected Rate of Compensation: Method of Accountability: Name of Consultant:372110015748000338836031877000341185547942500Organizational Affiliation (if applicable): Nature of Services to Be Rendered: Relevance of Service to the Project:408559015748000Number of Days of Consultation (basis for fee): Expected Rate of Compensation:Method of Accountability:Name of Consultant:372110015748000338836031877000341122047942500Organizational Affiliation (if applicable): Nature of Services to Be Rendered: Relevance of Service to the Project:408622515748000Number of Days of Consultation (basis for fee): Expected Rate of Compensation:Method of Accountability:Name of ConsultantOrganizational AffiliationExpected Rate of CompensationDHMH Amount RequestedTotal AmountTOTAL DHMH CONSULTANT COSTS REQUESTED$_ EQUIPMENTItem RequestedNumber NeededUnit CostDHMH Amount RequestedTotal AmountTOTAL DHMH EQUIPMENT REQUESTED$_ 4762526670000Summary Justification:SUPPLIESItem RequestedNumber NeededDHMH Amount RequestedTotal AmountTOTAL DHMH SUPPLIES REQUESTED$_ Summary Justification:476256667500TRAVEL-In-State OnlyNumber of TripsNumber of PeopleNumber of Total MilesCost per MileDHMHAmount RequestedTotal AmountTOTAL DHMH TRAVEL REQUESTED$_ Summary Justification:1365257302500OTHERItem RequestedNumber NeededDHMH Amount RequestedTotal AmountTOTAL DHMH OTHER REQUESTED$_ Summary Justification:95258699500CONTRACTUAL COSTSName of Contractor: Method of Selection: Period of Performance: Scope of Work: Method of Accountability: Itemized Budget and Justification: _________________________________________________________________ _________________________________________________________________ _________________________________________________________________Name of Contractor: Method of Selection: Period of Performance: Scope of Work: Method of Accountability: Itemized Budget and Justification: _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ Name of Contractor: Method of Selection: Period of Performance: Scope of Work: Method of Accountability: Itemized Budget and Justification: _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ Contractual ItemsName of OrganizationDHMH Amount RequestedTotal AmountTOTAL DHMH CONTRACTUAL COSTS REQUESTED$ DHMH COSTS REQUESTEDDHMH SALARIES/WAGES REQUESTED$ DHMH FRINGE BENEFITS REQUESTED$_ DHMH CONSULTANT COSTS REQUESTED$_ DHMH EQUIPMENT REQUESTED$_ DHMH SUPPLIES REQUESTED$_ DHMH TRAVEL REQUESTED$ DHMH OTHER REQUESTED$ DHMH CONTRACTUAL COSTS REQUESTED$ TOTAL DHMH DIRECT COSTS REQUESTED$ TOTAL DHMH INDIRECT COSTS REQUESTED$ TOTAL DHMH DIRECT AND INDIRECT COSTS REQUESTED $ ................
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